Robotic Assisted Resection of 16 Week Uterine Horn Pregnancy: A Minimally Invasive Approach to the Second Trimester Ectopic Pregnancy

Abstract

<h3>Study Objective</h3> To demonstrate by video our surgical approach of the resection of a second trimester rudimentary horn ectopic pregnancy. <h3>Design</h3> Case Report <h3>Setting</h3> University hospital. Patient in dorsal lithotomy position. <h3>Patients or Participants</h3> A 22-year-old primigravida presented at 16 weeks gestation following two failed elective terminations, in the setting of a spontaneous pregnancy with a known uterine anomaly. The patient reported a prior diagnostic laparoscopy revealing a left unicornuate uterus. Outside ultrasounds reported an intrauterine pregnancy however MRI upon admission revealed a fetus located within a thin-walled structure separate from the main uterine cavity, consistent with a rudimentary horn pregnancy. <h3>Interventions</h3> A fetal intracardiac potassium chloride injection was completed by maternal fetal medicine to halt the growth of the pregnancy during pre-operative planning. Tranexamic acid was administered preoperatively to minimize blood loss. Ureteral stents were placed to safely identify the ureters with the knowledge that Mullerian anomalies are often associated with concomitant renal abnormalities. Robotic assisted laparoscopy was used to resect the rudimentary uterine horn containing the 16-week gestation with ipsilateral ureterolysis and uterine artery ligation. <h3>Measurements and Main Results</h3> Exam under anesthesia and diagnostic laparoscopy revealed a unicornuate uterus with a communicating rudimentary horn. The procedure was uncomplicated with an estimated blood loss of 100cc. The patient's hemoglobin remained stable from 11.7 preoperatively to 10.8 postoperatively. She was meeting all milestones and discharged home on postoperative day one. <h3>Conclusion</h3> Rudimentary uterine horn pregnancies are rare and best managed by a multidisciplinary team. Robotic-assisted surgery may decrease blood loss, length of stay and comorbidities from surgery in the setting of a rudimentary horn ectopic pregnancy. Rather than assuming infertility, long-acting reversible contraceptives should be offered to women to prevent recurrence.